HomeMy WebLinkAboutpaw 2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: ^ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Ad d rens:
Address:
City:
City:
Zip: Phone:
Zip: ` Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signatur ontractor/License Holder
Signatur Owner/ Lessee/Contractor as. Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF - �. �' . 3 .
COUNTY OF `5 - '
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this ,-._ day of ,✓A,:,,—Q , 0 _ 20_L�f by
this L, day of i . 20 by
Name -'6f person making statement
Nam of person making statement
Personally Known OR Produced identification
Personally Known ice' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
` Al
P i
(Signature of Notar
(Signature of Notary Pu "
,aau�r, ME MARTIN
a4#,pY * •.
' `-; Notary - State of Florida
Commission No. .� (��}
IMy
4911�., MIKE MARTIN
,�'4,ar a �
Commission No. � � My Nots(rSr�di�lic -State at Florida
=• s •= Commission # FF 216951
= * •sCommission # FF 216951
�'+► ,. My Comm. Expires Apr 5, 2018
x'%:01t'ti'ad
'-�.* a Comm. Expires Apr 5, 2019
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through 4ational Notary Assn.
`--dow jgh National Notary ASS
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17